WASHINGTON – Most Americans think that health insurance should pay for emergency department visits for conditions believed by the patient to be urgent, according to a new survey commissioned by the American College of Emergency Physicians.
Some 85% of the survey respondents who had a regular physician said that when they had used the emergency department, they did so because they could not have waited to see that regular provider.
The survey, conducted by Harris Interactive, was commissioned as a counterbalance to increasing efforts by state Medicaid programs to curb ED visits, said Dr. David Seaberg, ACEP President.
Washington state was the first to seek limits on so-called nonemergent use of the ED by its Medicaid enrollees. Denial of coverage was going to be based on a list of 500 diagnoses the state had determined to be nonemergent. That policy has since been suspended.
But California, Illinois, Iowa, New Hampshire, and Tennessee have also been looking at restrictive policies. Dr. Seaberg said that his home state of Tennessee has been charging a screening fee only to Medicaid patients who end up having a nonemergent diagnosis. Emergency physicians are in discussions with the state to change that policy, he said at the ACEP Leadership and Advocacy Conference.
"We’re trying to protect the federal ‘prudent layperson’ standard," he said, referring to the federal law that requires health plans to cover ED visits if the patient believes he or she has a medical emergency.
In the survey of 1,026 adults conducted in mid-April, two-thirds agreed that health insurance should pay for an ED visit even if the condition is later diagnosed as nonserious or non–life threatening. Some 86% of those who had insurance said they thought ED visits should be covered when it applied to them personally.
Many of those surveyed said they had gone to the ED because they could not get in to see their regular provider or because they believed they could not wait. A total of 24% of those with private insurance and 35% of those with Medicare or Medicaid said they had tried to get an appointment before going to the ED but that either their physician told them to go to the hospital, the office was closed, or their physician could not see them soon enough.
When asked what they would do if emergency care was not covered, many of those surveyed said they’d be less likely to go to the emergency department. Of the 18- to 34-year olds, 83% said they’d be somewhat less likely to seek care in the ED; the percentage who would stay away declined with age, with only 63% of those aged 55 or older saying they’d be somewhat less likely to seek care in the ED.
The numbers are concerning, said Dr. Seaberg. If patients do not seek care, they may end up even sicker, which would be more costly to the health care system, he said.
Americans also seemed to lack knowledge about the true costs of ED care. According to ACEP, emergency department care accounts for less than 2% of total health care costs in the United States. Only 4% of survey respondents said that ED care accounts for less than 5% of health costs. Most vastly overestimated the cost of care, with 40% of respondents saying it was 26%-50% of health care costs and another quarter pegging the figure at 51%-75% of costs.
Even though emergency care is a small portion of the nation’s total health bill, emergency medicine still needs to work at reducing costs, Dr. Seaberg said. "We understand we need to [have a] value-based purchasing mindset, and we need to try to decrease our costs," he said, but added that it should be through methods other than limiting visits.
ACEP is also asking patients to sign an online petition calling on insurers and other payers, including Medicaid, to protect access to ED care. The petition is meant to show payers that the public feels that emergency care is important, Dr. Seaberg said.